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Milku ND, Abose DW, Gelaw KA, Mokonnon TM, Teshome MS. Challenges and coping strategies for providing maternal health care services among health care professionals in rural health facilities in Wolaita Zone, Southern Ethiopia: a qualitative study. BMC Health Serv Res 2024; 24:903. [PMID: 39113035 PMCID: PMC11308249 DOI: 10.1186/s12913-024-11389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Many factors can decrease job productivity and cause physical and psychological complications for health care professionals providing maternal care. Information on challenges and coping strategies among healthcare professionals providing maternal healthcare services in rural communities is crucial. However, there needs to be more studies, especially qualitative research, to explore challenges and coping strategies for providing maternal health care services in Ethiopia among health care professionals, particularly in the Wolaita zone. OBJECTIVE To explore the challenges and coping strategies of professionals providing maternal health care in rural health facilities in Wolaita Zone, Southern Ethiopia, in 2023. METHOD A phenomenological qualitative study design was applied from May 20 to June 20, 2023. The study was conducted in rural areas of the Wolaita Zone, southern Ethiopia. Healthcare professionals from rural areas were selected using purposive sampling, and in-depth interviews were conducted. A qualitative thematic analysis was employed to analyze the data. Field notes were read, recordings were listened to, and each participant's interview was written word for word and analyzed using ATLAS.ti 7 software. RESULT Five main themes emerged from the data analysis. These themes included inadequate funding from the government, societal barriers to health and access to health care, professionals' personal life struggles, infrastructure related challenges and health system responsiveness, and coping strategies. Reporting to responsible bodies, teaching mothers about maternal health care services, and helping poor mothers from their pockets were listed among their coping strategies. CONCLUSION Healthcare professionals have a crucial role in supporting women in delivering babies safely. This study revealed that they are working under challenging conditions. So, if women's lives matter, then this situation requires a call to action.
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Affiliation(s)
- Netsanet Demissie Milku
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Diriba Wakjira Abose
- School of Midwifery, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kelemu Abebe Gelaw
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Taklu Marama Mokonnon
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Makeda Sinaga Teshome
- School of Midwifery, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia
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Carvajal B, Hancock A, Lewney K, Hagan K, Jamieson S, Cooke A. A global overview of midwives' working conditions: A rapid review of literature on positive practice environment. Women Birth 2024; 37:15-50. [PMID: 37648619 DOI: 10.1016/j.wombi.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/24/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND In the United Kingdom (UK), a critical shortage of midwives puts pressure on the already overworked midwives working in maternity services. Considering the challenges that midwives in the UK face, this rapid review was conducted to inform a larger-scale initiative to improve the working conditions of midwives in an acute NHS Trust in the Midlands area of the UK. OBJECTIVE To describe midwives' perceptions and experiences of positive practice environments. METHODS A search strategy to identify literature about midwives' perceptions and experiences of positive practice environments was conducted in Medline, CINAHL Plus and Embase databases. Literature screening was conducted independently in two steps using an eligibility tool. The articles' quality assessment was conducted using the Mixed Method Appraisal Tool. Data were extracted using the Job Quality framework and managed using NVivo12. RESULTS Seventy articles were included in this review. Midwives' working conditions can be improved in all seven areas of the Job Quality framework. Most articles in the review reported the negative aspects of midwives' working environments, making it challenging for the team to define a positive practice environment for midwives. Despite this, authors discuss that a positive practice environment is at least sustained by ensuring midwives' ability to provide care; providing good employment conditions; developing respectful organisations; and increasing team resources, such as those that improve team resilience. CONCLUSIONS Midwives' working conditions are universally challenging. Failure to address the situation will compromise recruitment and retention, increasing the shortage of midwives. Provision of safe and respectful care appears to be directly linked to midwives' safe and respectful working conditions.
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Affiliation(s)
- Bielka Carvajal
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK; Division of Nursing, Midwifery and Social Work, The University of Manchester, UK; Departamento de Promocion de la Salud de la Mujer y el Recien Nacido, Universidad de Chile, Chile.
| | - Angela Hancock
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK; Division of Nursing, Midwifery and Social Work, The University of Manchester, UK; School of Nursing and Midwifery, Keele University, UK
| | - Katharine Lewney
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK
| | - Karen Hagan
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK
| | - Sarah Jamieson
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK
| | - Alison Cooke
- Centre for NMAHP Research and Education Excellence (CeNREE), University Hospitals of North Midlands NHS Trust, UK; Division of Nursing, Midwifery and Social Work, The University of Manchester, UK; School of Nursing and Midwifery, Keele University, UK
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Ismaila Y, Bayes S, Geraghty S. Midwives' experiences of the consequences of navigating barriers to maternity care. Health Care Women Int 2023:1-21. [PMID: 38032686 DOI: 10.1080/07399332.2023.2284771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
Midwives in Low- and middle-income countries, experience myriad barriers that have consequences for them and for maternity care. This article provides insight into the consequences of the barriers that Ghanaian midwives face in their workplaces. Glaserian Grounded Theory methodology using semi-structured interviews and non-participant observations was applied in this study. The study participants comprised of 29 midwives and a pharmacist, a social worker, a health services manager, and a National Insurance Scheme manager in Ghana. Data collection and analysis occurred concurrently while building on already analyzed data. In this study it was identified that barriers to Ghanaian midwives' ability to provide maternity care can have physiological, psychological, and socioeconomic consequences for midwives. It also negatively impacted maternity care. Implementing new ameliorating measures to mitigate the barriers that Ghanaian midwives encounter, and the consequences that those barriers have on them would improve midwife retention and care quality.
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Affiliation(s)
- Yakubu Ismaila
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sara Bayes
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sadie Geraghty
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Faculty of Medicine, Nursing, Midwifery and Health Sciences, The University of Notre Dame, Fremantle, Western Australia, Australia
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Schuler C, Agbozo F, Ntow GE, Waldboth V. Health-system drivers influencing the continuum of care linkages for low-birth-weight infants at the different care levels in Ghana. BMC Pediatr 2023; 23:501. [PMID: 37798632 PMCID: PMC10552361 DOI: 10.1186/s12887-023-04330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Low birth weight (LBW) is associated with short and long-term consequences including neonatal mortality and disability. Effective linkages in the continuum of care (CoC) for newborns at the health facility, community (primary care) and home care levels have a high tendency of minimizing adverse events associated with LBW. But it is unclear how these linkages work and what factors influence the CoC process in Ghana as literature is scarce on the views of health professionals and families of LBW infants regarding the CoC. Therefore, this study elicited the drivers influencing the CoC for LBW infants in Ghana and how linkages in the CoC could be strengthened to optimize quality of care. METHODS A constructivist grounded theory study design was used. Data was collected between September 2020 to February 2021. A total of 25 interviews were conducted with 11 family members of LBW infants born in a secondary referral hospital in Ghana, 9 healthcare professionals and 7 healthcare managers. Audio recordings were transcribed verbatim, analyzed using initial and focused coding. Constant comparative techniques, theoretical memos, and diagramming were employed until theoretical saturation was determined. RESULTS Emerging from the analysis was a theoretical model describing ten major themes along the care continuum for LBW infants, broadly categorized into health systems and family-systems drivers. In this paper, we focused on the former. Discharge, review, and referral systems were neither well-structured nor properly coordinated. Efficient dissemination and implementation of guidelines and supportive supervision contributed to higher staff motivation while insufficient investments and coordination of care activities limited training opportunities and human resource. A smooth transition between care levels is hampered by procedural, administrative, logistics, infrastructural and socio-economic barriers. CONCLUSION A coordinated care process established on effective communication across different care levels, referral planning, staff supervision, decreased staff shuffling, routine in-service training, staff motivation and institutional commitment are necessary to achieve an effective care continuum for LBW infants and their families.
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Affiliation(s)
- Christina Schuler
- School of Health Sciences, Institute of Nursing, Zurich University of Applied Sciences (ZHAW), Winterthur, Switzerland
| | - Faith Agbozo
- FN Binka School of Public Health, Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | | | - Veronika Waldboth
- School of Health Sciences, Institute of Nursing, Zurich University of Applied Sciences (ZHAW), Winterthur, Switzerland
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Sangy MT, Duaso M, Feeley C, Walker S. Barriers and facilitators to the implementation of midwife-led care for childbearing women in low- and middle-income countries: A mixed-methods systematic review. Midwifery 2023; 122:103696. [PMID: 37099826 DOI: 10.1016/j.midw.2023.103696] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/22/2023] [Accepted: 04/11/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Evidence from high-income countries demonstrate improvements in maternal and neonatal health with midwife-led care. Midwife-led care is pivotal to meet the United Nations' Sustainable Development Goals. Despite this, successful implementation of midwife-led care in low- and middle-income countries (LMICs) has been limited. It is therefore necessary to understand the factors that influence the implementation of midwife-led care. AIM This systematic review aimed to synthesize the evidence on barriers and facilitators to the implementation of midwife-led care for childbearing women in LMICs from the perspectives of care recipients, providers and wider stakeholders. METHODS A mixed-methods systematic review was conducted of primary research studies that expressed the views of those involved in or affected by the implementation of midwife-led care in LMICs. Reporting followed PRISMA guidelines. MEDLINE, EMBASE, PsychINFO, CINAHL, Maternity and Infant Care database (MIDIRS), Global Health and Web of Science databases were systematically searched. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Data was analysed and synthesized using the Supporting the Use of Research Evidence (SURE) framework to identify barriers and enabling factors to implementing midwife-led care. FINDINGS A total of 31 studies from 21 LMICs were included. At the care recipient level, women need adequate knowledge and confidence about midwife-led care to utilise services. At the care provider level, strengthening midwifery education and practice by employing experienced educators and supervisors is essential. Findings also suggest that increased collaboration between funders, professional organisations, practitioners, communities, and the government is necessary for successful implementation. However, adequate and sustained funding for midwife-led care programs is often lacking and political instability contributes to poor implementation in LMICs. CONCLUSION AND IMPLICATIONS FOR PRACTICE AND RESEARCH There are several enabling factors which increase the success and sustainability of the midwife-led model of care in LMICs. However, current practice guidelines and strategic frameworks need to better reflect the infrastructure and resource limitations of health settings in LMICs.
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Affiliation(s)
- Marie Therese Sangy
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings' College, London, UK.
| | - Maria Duaso
- Senior Lecturer, Florence Nightingale Faculty of Nursing, Midwifery and Palliative care, Kings' College, London, UK
| | - Claire Feeley
- Lecturer (Research & Teaching), Florence Nightingale Faculty of Nursing, Midwifery and Palliative care, Kings' College, London, UK
| | - Shawn Walker
- Senior Research Fellow, Florence Nightingale Faculty of Nursing, Midwifery and Palliative care, Kings' College, London, UK
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Becker J, Becker C, Abeysekera R, Moir J, Gray M, Shimwela M, Oprescu F. Silent Tears of Midwives: 'I Want Every Mother Who Gives Birth to Have Her Baby Alive'-A Narrative Inquiry of Midwives Experiences of Very Early Neonatal Death from Tanzania. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040705. [PMID: 37189954 DOI: 10.3390/children10040705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Midwives working in settings with limited clinical resources experience high rates of very early neonatal deaths. Midwives manage the impact of this grief and trauma almost daily, which may affect patient care and their own well-being. RESEARCH AIMS To explore how midwives are impacted by and cope with high rates of very early neonatal deaths. To document midwives' insights and local solutions that may reduce very early neonatal deaths in limited resource settings. To document the stories of midwives in order to create awareness and garner support for midwives and their critical work in low resource settings. METHODS Narrative inquiry utilizing semi structured interviews. Twenty-one midwives with at least six months experience who had experienced or witnessed very early neonatal death were interviewed. Data were audio recorded and transcribed, and reflexive thematic analysis of transcripts was conducted. RESULTS AND DISCUSSION Three themes were identified: (1) deep sadness resulting from very early neonatal deaths leading to internal struggles; (2) use of spirituality, including prayer and occasional beliefs that unexplainable deaths were 'God's plan'; and (3) development of resilience by seeking solutions, educating themselves, taking accountability and guiding mothers. Participating midwives noted that inadequate staff and high caseloads with limited basic supplies hindered their clinical practice. Participants articulated that they concentrated on active solutions to save babies during labour, such as vigilant foetal rate heart monitoring and partogram. Further, reduction and prevention of very early neonatal death is a complex problem requiring multidisciplinary teams and woman-centred care approaches to address issues contributing to the health of mothers and their new-borns. CONCLUSIONS Midwives' narratives highlighted ways of coping with grief and deep sadness, through prayer, and further education of both mothers and fellow colleagues to achieve better antenatal and intrapartum care and outcomes. This study gave midwives an opportunity for their voices to be heard and to generate solutions or insights that can be shared with colleagues in similar low-resource settings.
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Affiliation(s)
- Jan Becker
- Midwife Vision Global, Uhuru Street, Dar es Salaam 12101, Tanzania
| | - Chase Becker
- Midwife Vision Global, Uhuru Street, Dar es Salaam 12101, Tanzania
| | - Rachel Abeysekera
- Medical School, University of Nicosia in Partnership with St George's University of London, Makedonitissis 46, Nicosia 2417, Cyprus
| | - James Moir
- Midwife Vision Global, Uhuru Street, Dar es Salaam 12101, Tanzania
| | - Marion Gray
- Centre for Health Research, School of Health and Wellbeing, Faculty of Health, Engineering and Sciences, University of the Southern Queensland, Toowoomba, QLD 4300, Australia
| | - Meshack Shimwela
- Temeke Regional Referral Hospital, Dar es Salaam 15101, Tanzania
| | - Florin Oprescu
- Public Health, University of Sunshine Coast, Sippy Downs, QLD 4556, Australia
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Understanding the barriers to Ghanaian midwives’ ability to provide quality care: Using classic Grounded theory methodology in a new context. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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